Healthcare Provider Details

I. General information

NPI: 1396269130
Provider Name (Legal Business Name): BRYAN REAGAN AYCOCK CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 VICTORIA RD
ASHEVILLE NC
28801-4419
US

IV. Provider business mailing address

75 VICTORIA RD
ASHEVILLE NC
28801-4419
US

V. Phone/Fax

Practice location:
  • Phone: 828-254-6305
  • Fax:
Mailing address:
  • Phone: 828-254-6305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: